This 15 August will mark the fourth anniversary of Prime Minister Narendra Modi’s clarion call to rid India of open defecation. As we inch closer towards the envisioned deadline of 2 October 2019, one thing stands out: the stark similarity in sanitation programmes across different governments and political hues since 1986.

All of them have focused on just building toilets.

The Central Rural Sanitation Programme (CRSP) of 1986-1999 first introduced large-scale, state-funded toilet construction drives in rural homes, recognising the intrinsic link between key health outcomes and open defecation. Celebrated as a pioneering initiative then, the very same intervention has continued to be the cornerstone of India’s sanitation policy.

The Total Sanitation Campaign (TSC) of 1999-2012, the Nirmal Bharat Abhiyan (NBA) of 2012-2014, and the Swachh Bharat Abhiyan (SBA) since 2014 have, with minor exceptions, all focused on building toilets, each more aggressively than its predecessor. Usage wasn’t part of the tangible outcome of these initiatives for long.

It took nearly two decades, and several alarm bells from academia, NGOs and donors, for the government of India to even mention toilet use as an outcome of evaluation for sanitation policy in the National Sample Survey Organisation (NSSO) report of 2016, and the National Annual Rural Sanitation Survey (NARSS) of 2017-2018.

Before this, all nationwide surveys under the government of India, including the Census, the National Family Health Survey and evaluation reports by the drinking water and sanitation ministry, either made no distinction between the use of toilets and their construction, or did not include usage as a metric of evaluation.

Understanding Toilet Use

Various reports indicated that more than half the toilets under the Centre’s rural sanitation programme were not being used. Poor maintenance, multiple funding agencies and poor community buy-in were identified as possible reasons. But the programmes that followed, although based on the Community Led Total Sanitation (CLTS) model for facilitating behaviour change, still steadfastly emphasised on building toilets.

In 2014, the Sanitation Quality, Use, Access and Trends (SQUAT) survey from the RICE institute pointed out that 40 per cent households with working toilets had at least one member defecating in the open. The recent NSSO report said toilet usage stands at 95.6 per cent. But the methodology of the survey has been questioned – household toilet use has only been partially disaggregated in the form of adult males, adult females, et al and not individuals. Further, the phrasing of the question gives away an inherent preference for toilet use that may possibly have influenced survey respondents. At the very least, we need more studies on larger and more representative samples to produce these results on toilet use, before celebrating any successes.

India’s sanitation programme till date has failed to agree on a uniform and universally accepted metric for measuring toilet use. Independent studies have relied on different forms of observational data, such as the presence of chappals outside toilets, the “look” of the toilets, or self-declaration of toilet use.

Monitoring and evaluation of ODF status

Declaration of ODF (open defecation free) status remains largely an episodic approach rather than a process-driven one. What is required is a system based on continuous monitoring and evaluation. Toilets are constructed, homes are ticked off government checklists, and villages and districts and states are declared ODF on that basis.

The Nirmal Gram Puraskar, conceived in 2003, was given 2005 onwards to villages that were classified as ODF on the basis of self-declaration, followed by verification by state governments and the ministry of drinking water and sanitation, and promised “random checks” on paper by the Centre.

A Nirmal Gram was defined as one where a) all villages have access to sanitary toilets, b) all schools and angawadis have access to toilets, c) it is free from open defecation and d) maintenance of clean environment is ensured.

Reports from numerous media organisations and academic study teams found on periodical inspections that household toilets in these villages were converted to kitchens, cowsheds and storehouses months or a few years after the certification.

The SBA on 9 June 2015 defined ODF status as: “ODF is the termination of faecal-oral transmission, defined by a) no visible faeces found in the environment/village, and b) every household as well as public/community institutions using safe technology option for disposal of faeces”. Note the similarities in the definitions, with the only welcome addition being the attention given to the disposal of solid waste.

Since then, ODF status is self-declared following a meeting of the gram sabha and a standard pro forma by the district authority, an approach very similar to the NBA. Following this, a one-time verification is carried out within three months by state authorities, and a follow-up verification is done, also by state authorities, in another six months, after which verification certificates are issued. Annual verification by the Centre still remains on paper.

Behaviour change

The government has looked at sanitation as a supply side problem, to be addressed through subsidised toilets. Despite a plethora of studies since the late 1990s highlighting that construction of toilets alone does not lead to change in a fundamental habit like toilet behaviour, governments have continued to celebrate how they surpassed their predecessors in toilet construction.

As money is pumped into toilet-building, the budget to address behaviour change has been brought down. The 15 per cent allocation to the information, education, and communication component of the budget in the TSC came down to 8 per cent under the SBM, and in this, the central share is only 3 per cent.

India’s strategy for behavioural change has remained consistently unimaginative in its approach. The CLTS model has been used to shame open defecators squatting in villages through community volunteers (Swachhata doots under UPA, Swachhagiris or Swachha Nigrani Samitis under NDA), or scaring people into using toilets through campaigns like linking toilets to women’s safety. Almost three decades of literature in behaviour change has shown both strategies do little to inculcate positive behaviours, and hardly help in their long-term sustenance. And yet, India has continued to determinedly follow both approaches.

Supply of a different kind

A different stream of experts argues that India’s sanitation crisis is indeed a supply side problem. They say the use of toilets is intertwined with toilet design, the supply of water and sewage systems. They say without addressing the latter, building the four walls of a toilet will do little to target sanitation behaviour. They argue that by building dry toilets in the absence of these fundamental structural changes, governments are trying to provide stop-gap arrangements, despite evidence that it is not working.

Simply put, sanitation policy in India has unfortunately been a generous dose of very old wine in new, increasingly well-packaged bottles. Many lessons and opportunities for overhaul were wasted. This stagnation is most acute when it comes to rural sanitation.

Sadly, the only element that has changed is the targets we set for ourselves. After the UPA’s 2022 goal for NBA, we are awaiting the 2019 deadline for SBA. Many experts have said setting such deadlines may force local governments into a further frenzy to construct toilets, thus diverting them from providing long-term solutions for rural sanitation in a hurry to produce results on paper.

(This is the first in a four-part series on Swachh Bharat Abhiyan. Read the second part here.)

Pritha Chatterjee is a journalist and a PhD student in population health sciences at Harvard University.

3 COMMENTS

The writer should agree that the first toilets are required to address open defecation. So enough of these should be built fast for all who do not have it. Simultaneously, water and other issues should be attacked. With availability of toilets, all kind of persuasion and coercion should be applied for use of toilets. If toilets are available, younger generation will be more willing to use it and persuade to older generation. The problem is also with Indian public, both educated and uneducated who takes sanitation out side home very lightly and rather negatively contribute in maintaining ODF and sanitation.